Mesenteric Venous Thrombosis

Aka: Mesenteric Venous Thrombosis, Mesenteric Vein Thrombosis

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II. Epidemiology

  1. Accounts for 5-15% of Acute Mesenteric Ischemia
  2. Gender: Women are more commonly affected

III. Pathophysiology

  1. Superior Mesenteric Artery is affected in most cases

IV. Causes

  1. Prothrombotic state (70% of cases)
    1. Family History of Venous Thromboembolism (50% of cases)
    2. Cancer
    3. Thrombophilia

V. Risk Factors

  1. Tobacco Abuse
  2. Oral Contraceptive use
  3. Hypercoagulable State
  4. Abdominal Trauma (especially significant Trauma such as seen in Motor Vehicle Accident)

VI. Symptoms

  1. Presentation is often delayed 48 hours or more after onset
  2. Mid-abdominal, colicky pain
    1. May still eat despite pain
  3. Nausea
  4. Vomiting
  5. Diarrhea

VII. Signs

  1. Fecal Occult Blood stool (50%)
  2. Grossly bloody stool (15%)

VIII. Labs

  1. Lactic Acidosis is a late finding

IX. Imaging

  1. Abdominal Xray
    1. Early: Mild bowel dilation
    2. Late: Thumb printing, pneumatosis, portal venous gas
  2. Abdominal CT
    1. Test Sensitivity: 90%
  3. Abdominal Ultrasound with venous doppler

X. Management

  1. See Mesenteric Ischemia
  2. Anticoagulation
    1. Start with Heparin infusion
      1. Associated with improved survival (especially if started early)
    2. Transition to Warfarin (continue for >=6 months)
  3. Surgery

XI. Prognosis

  1. Mortality: 20-50%

XII. References

  1. Fraboni (2012) Board Review Express, San Jose
  2. Kern and Gilley-Avramis (2022) Crit Dec Emerg Med 36(11) 21-8
  3. Mastoraki (2021) World J Gastrointest Pathophysiol 7(1): 125-30 [PubMed]

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